Endovascular Therapy for Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage (RESCUE-CV)

Endovascular Therapy for Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage: The RESCUE-CV Randomized Trial

Cerebral vasospasm is a common and serious complication after aneurysmal subarachnoid hemorrhage and is an important cause of delayed cerebral ischemia and poor neurological outcomes. Although standardized medical management is widely used, effective treatment options for cerebral vasospasm remain limited.

Endovascular treatment, including intra-arterial drug infusion and mechanical angioplasty, may relieve vasospasm and improve cerebral perfusion after aneurysmal subarachnoid hemorrhage. However, most available evidence comes from retrospective or observational studies, and high-quality randomized evidence remains insufficient. Milrinone is a phosphodiesterase inhibitor with multiple potentially beneficial effects, including vasodilation, positive inotropic activity, anti-inflammatory properties, and endothelial protection. These effects may make milrinone a promising therapeutic agent for relieving cerebral vasospasm, reducing delayed cerebral ischemia, and ultimately improving clinical outcomes after aneurysmal subarachnoid hemorrhage.

This study is a multicenter, prospective, randomized controlled clinical trial designed to evaluate whether early continuous milrinone-based endovascular therapy improves outcomes in patients with cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Eligible participants will be randomly assigned to receive either standardized medical management alone or milrinone-based endovascular therapy plus standardized medical management. In the intervention group, patients will receive intra-arterial milrinone during endovascular treatment, with mechanical angioplasty when clinically indicated, followed by continuous intravenous milrinone infusion for 72 hours after intra-arterial administration.

The study will evaluate whether this continuous treatment strategy reduces poor neurological outcomes at 3 months after randomization. It will also assess the effects of treatment on delayed cerebral ischemia, vasospasm resolution, cognitive function, quality of life and so on. The results of this trial may provide high-quality evidence for early continuous milrinone-based endovascular therapy as a treatment strategy for cerebral vasospasm after aneurysmal subarachnoid hemorrhage.

Study Overview

• Status: Not yet recruiting
• Conditions: Subarachnoid Hemorrhage, Aneurysmal; Cerebral Vasospasm After Subarachnoid Hemorrhage
• Intervention / Treatment: Other: Standardized Medical Management; Other: Intra-arterial and Intravenous Milrinone Therapy

• Study Type: Interventional
• Enrollment (Estimated): 306
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Wenqiang Li, MD; Phone Number: 13521199810; Email: lwqsurgeon@163.com

Study Locations

• China
  • Beijing Municipality
    • Beijing, Beijing Municipality, China, 100070
      • Department of Neurosurgery, Beijing Tiantan Hospital
      • Contact: Wenqiang Li, MD; Phone Number: 13521199810; Email: lwqsurgeon@163.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

Participants must meet all of the following criteria:

1. Aged 18 to 80 years.
2. SAH confirmed by cranial CT, with an intracranial aneurysm identified by CTA, MRA, or DSA and determined to be the source of bleeding.
3. Prior treatment of the aneurysm by endovascular intervention or surgical clipping.

4. Evidence suggestive of CVS within 14 days after onset, defined by at least one of the following:

   1. Clinical deterioration, including a decrease in GCS score of >2 points and/or a new focal neurological deficit not attributable to another known neurological cause;
   2. TCD confirmed vasospasm, defined as mean flow velocity (MFV) >120 cm/s in the middle cerebral artery (MCA) and Lindegaard ratio >3, after excluding other causes of increased flow velocity such as anemia or fever;
   3. Vasospasm confirmed by DSA or CTA.

Exclusion Criteria:

1. Hunt-Hess grade 5 with critical illness and inability to tolerate intervention.
2. Contraindications to milrinone, including milrinone allergy, aortic or pulmonary valve stenosis, obstructive hypertrophic cardiomyopathy, acute coronary syndrome, or malignant arrhythmia.
3. Perioperative procedure-related complications that may interfere with study assessment, such as significant stenosis of the parent artery.
4. Irreversible cerebral infarction involving the entire vascular territory affected by vasospasm.
5. Poor blood pressure control, defined as systolic blood pressure <100 mmHg.
6. Non-aneurysmal SAH, including hemorrhage due to arteriovenous malformation, vasculitis, tumor bleeding, trauma, or other non-spontaneous causes, or cases without an identified bleeding source.
7. Other severe neurological disorders with substantial pre-existing disability (mRS >3), such as progressive cognitive impairment or status epilepticus.
8. Severe systemic disease, including significant cardiac, hepatic, renal, or psychiatric disorders.
9. Pregnant or breastfeeding women, or women planning pregnancy during the study period.
10. Any other condition considered by the investigators to make the patient unsuitable for participation or likely to limit compliance with study procedures.
11. Current participation in another interventional clinical study, inability to complete follow-up assessments, or failure to provide informed consent.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Control Group (Standardized Medical Management Group); Participants assigned to the control group will receive standardized medical management after aneurysm treatment for aSAH, including oral or enteral nimodipine at a total daily dose of 360 mg, maintenance of euvolemia, blood pressure augmentation when clinically indicated to support cerebral perfusion, and other guideline-recommended supportive treatments.	Other: Standardized Medical Management; Standardized medical management will be provided after aneurysm treatment for aSAH. It will include oral or enteral nimodipine at a total daily dose of 360 mg, fluid management with 24-hour intake and output monitoring to maintain euvolemia, blood pressure augmentation when clinically indicated to support cerebral perfusion, and other guideline-recommended supportive treatments.
Experimental: Experimental Group (Continuous Milrinone-Based Endovascular Therapy Plus Standardized Medical Mana ); Participants assigned to this arm will receive standardized medical management as described for the comparator arm plus continuous milrinone-based endovascular therapy. Endovascular angiography will be performed, followed by intra-arterial milrinone 8 mg infused into the artery supplying the vasospastic territory over approximately 30 minutes. The dose may be repeated if clinically needed, with a maximum total intra-arterial dose of 24 mg. Mechanical angioplasty may be considered for persistent severe proximal stenosis. After intra-arterial treatment, intravenous milrinone will be continued for 72 hours at 0.5 to 1.5 μg/kg/min according to clinical need and tolerability. If vasospasm recurs, the treatment protocol may be repeated at the investigator's discretion.	Other: Standardized Medical Management; Standardized medical management will be provided after aneurysm treatment for aSAH. It will include oral or enteral nimodipine at a total daily dose of 360 mg, fluid management with 24-hour intake and output monitoring to maintain euvolemia, blood pressure augmentation when clinically indicated to support cerebral perfusion, and other guideline-recommended supportive treatments.; Other: Intra-arterial and Intravenous Milrinone Therapy; Continuous milrinone-based endovascular therapy will be administered in addition to standardized medical management. Cerebral angiography will first be performed, followed by intra-arterial infusion of milrinone 8 mg into the artery supplying the vasospastic territory over approximately 30 minutes. If vasodilation is incomplete, the infusion may be repeated once in the same territory. For diffuse vasospasm, milrinone may be administered in different vascular territories, with a maximum total intra-arterial dose of 24 mg. If severe proximal stenosis persists after intra-arterial treatment, mechanical angioplasty may be performed at the operator's discretion. After intra-arterial treatment, intravenous milrinone will be continued for 72 hours, starting at 0.5 mcg/kg/min and gradually increasing to a maximum of 1.5 mcg/kg/min when clinically needed and well tolerated. If vasospasm recurs, the treatment protocol may be repeated at the investigator's discretion.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Neurological function prognosis	The primary outcome is poor neurological outcome within 90 days after randomization, defined as a modified Rankin Scale (mRS) score of 3-6.	Up to 90 days after randomization

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Delayed cerebral ischemia	new focal neurological deficit or decreased level of consciousness within 3 weeks after treatment, not attributable to rebleeding, seizure, infection, metabolic disturbance, or other causes, with imaging support for ischemic change (CT/MRI as applicable)	Up to 21 days after randomization
Vasospasm resolution rate	Proportion of participants with vasospasm resolution within 21 days after randomization, defined as a reduction in mean flow velocity of the vasospastic vessel to <120 cm/s on transcranial Doppler, or improvement in vasospasm severity compared with baseline. CTA or DSA may be used when clinically necessary.	Up to 14 days after randomization/at discharge
Severity of patients' clinical condition	assessed at 3 weeks by WFNS grade after treatment, with change from baseline recorded	Up to 21 days after randomization。
Cognitive function assessed using the Montreal Cognitive Assessment (MoCA) at baseline and 90 Days	Cognitive function will be assessed using the Montreal Cognitive Assessment (MoCA). The MoCA total score ranges from 0 to 30, with higher scores indicating better cognitive function.	at baseline and 90 days after randomization
Health-related quality of life assessed using the EuroQol 5-Dimension questionnaire (EQ-5D) at 90 Days	Health-related quality of life will be assessed using the EuroQol 5-Dimension questionnaire (EQ-5D). The EuroQol Visual Analog Scale (EQ VAS) score ranges from 0 to 100, with higher scores indicating better health-related quality of life.	90 days after randomization
Total Hospitalization Cost	Total hospitalization cost will be calculated as the total cost incurred during the index hospitalization	Up to 14 days after randomization/at discharge
Length of Total Hospital Stay	Total hospital stay will be measured as the number of days from randomization to hospital discharge	Up to 14 days after randomization/at discharge
Length of Intensive Care Unit Stay	Intensive care unit stay will be measured as the total number of days spent in the intensive care unit during the index hospitalization	Up to 14 days after randomization/at discharge

Collaborators and Investigators

• Sponsor: Beijing Tiantan Hospital
• Collaborators: The First Affiliated Hospital of Nanchang University; Chinese PLA General Hospital; Second Affiliated Hospital, School of Medicine, Zhejiang University; Hebei General Hospital; Zhongnan Hospital; Henan Provincial People's Hospital; First Affiliated Hospital of Xinjiang Medical University; First Affiliated Hospital of Harbin Medical University; First Affiliated Hospital of Wannan Medical College; Shaoyang Central Hospital; Binzhou Medical University; Nanfang Hospital, Southern Medical University; Ji'an Central People's Hospital; The second People's Hospital of Guiyang; The First Affiliated Hospital of Henan Medical University; Hunan University of Medicine General Hospital
• Investigators: Study Chair: Xinjian Yang, MD, Beijing Tiantan Hospital; Study Chair: Liping Liu, MD, Beijing Tiantan Hospital

Publications and helpful links

General Publications

• Boulouis G, Labeyrie MA, Raymond J, Rodriguez-Regent C, Lukaszewicz AC, Bresson D, Ben Hassen W, Trystram D, Meder JF, Oppenheim C, Naggara O. Treatment of cerebral vasospasm following aneurysmal subarachnoid haemorrhage: a systematic review and meta-analysis. Eur Radiol. 2017 Aug;27(8):3333-3342. doi: 10.1007/s00330-016-4702-y. Epub 2016 Dec 21.
• Lakhal K, Hivert A, Alexandre PL, Fresco M, Robert-Edan V, Rodie-Talbere PA, Ambrosi X, Bourcier R, Rozec B, Cadiet J. Intravenous Milrinone for Cerebral Vasospasm in Subarachnoid Hemorrhage: The MILRISPASM Controlled Before-After Study. Neurocrit Care. 2021 Dec;35(3):669-679. doi: 10.1007/s12028-021-01331-z. Epub 2021 Sep 3.
• Fraticelli AT, Cholley BP, Losser MR, Saint Maurice JP, Payen D. Milrinone for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Stroke. 2008 Mar;39(3):893-8. doi: 10.1161/STROKEAHA.107.492447. Epub 2008 Jan 31.
• Jabbarli R, Pierscianek D, Rolz R, Darkwah Oppong M, Kaier K, Shah M, Taschner C, Monninghoff C, Urbach H, Beck J, Sure U, Forsting M. Endovascular treatment of cerebral vasospasm after subarachnoid hemorrhage: More is more. Neurology. 2019 Jul 30;93(5):e458-e466. doi: 10.1212/WNL.0000000000007862. Epub 2019 Jul 5.

Study record dates

Study Major Dates

• Study Start (Estimated): June 1, 2026
• Primary Completion (Estimated): December 31, 2028
• Study Completion (Estimated): December 31, 2029

Study Registration Dates

• First Submitted: June 1, 2026
• First Submitted That Met QC Criteria: June 10, 2026
• First Posted (Actual): June 12, 2026

Study Record Updates

• Last Update Posted (Actual): June 12, 2026
• Last Update Submitted That Met QC Criteria: June 10, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Outcomes; Cerebral vasospasm; Milrinone; aneurysmal subarachnoid hemorrhage; Endovascular Therapy
• Additional Relevant MeSH Terms: Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Pathologic Processes; Hemorrhage; Intracranial Hemorrhages; Pathological Conditions, Signs and Symptoms; Subarachnoid Hemorrhage; Vasospasm, Intracranial; Therapeutics; Drug Administration Routes; Drug Therapy; Infusions, Parenteral; Infusions, Intra-Arterial
• Other Study ID Numbers: KY2026-149-02

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared because of patient privacy, ethical restrictions, and the absence of a predefined data-sharing mechanism.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No